Utility of intraoperative real-time near-infrared fluorescence surgery for spinal schwannoma

The authors report the first cases of fluorescence-guided spinal surgery of schwannomas using near-infrared fluorescence imaging with the delayed window indocyanine (ICG) green (DWIG) technique for accurate real-time intraoperative tumor visualization. Patients with intradural spinal schwannomas received 0.5 mg/kg ICG at the beginning of surgery. After 1 hour, using the DWIG technique, near-infrared spectroscopy (NIRS) detected the spinal schwannomas, showing the exact tumor location and boundaries. DWIG with NIRS microscopy confirmed the exact location of spinal schwannomas before and after opening of the dura mater, thereby facilitating successful tumor dissection from the surrounding tissues, tumor resection, and confirmation of tumor removal. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21158

Cauda equina schwannoma presenting with subarachnoid and subdural hemorrhage: Its underlying mechanism

Background: A patient presented with a spinal subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) attributed to a spinal schwannoma at the T12-L1 level. Case Description: A 67-year-old male acutely presented with severe back pain and L1 paraparesis/sensory loss, with urinary incontinence. CT/MR studies showed a spinal SAH and SDH within a likely T12-L1 schwannoma. At surgery, the hemorrhage within the tumor was continuous through the lower pole of the tumor into the subarachnoid and subdural spaces; tumor was dissected away from the surrounding tissues and totally removed. The postoperative course was uneventful, and the preoperative neurological deficits gradually resolved. Histopathologically, the lesion was a schwannoma with intratumoral hemorrhage. Conclusion: This case demonstrates the rare acute presentation of a T12-L1 schwannoma with an accompanying intratumoral hemorrhage resulting in both a SDH/SAH.

The outcome of surgical resection in complete paraplegia patient due to thoracic schwannoma

Spinal schwannoma is the most common benign intradural spinal tumor. However, studies regarding the neurological outcome of tumor resection in complete paraplegia patients are still lacking. The authors report a case of complete paraplegia due to primary intradural extramedullary low-grade schwannoma of the spinal cord. Surgery was performed 5 weeks after the paraplegia complaint first occurred. The patient did not regain motor nor sensory function in the 1-month follow-up but resolution of pain was achieved. The patient was able to perform daily activity more comfortably. In the event of complete paraplegia, surgery should still be offered promptly as it can still benefit the patient. Possible factors that could have influenced the prognosis in our study are discussed.

Microsurgical Resection and Stabilization of a Giant Spinal Schwannoma: 2-Dimensional Operative Video

We illustrate the microsurgical resection of a giant lumbar spinal schwannoma in a 37-yr-old male who presented with worsening low back pain, weakness, and numbness and tingling in the bilateral legs and feet. Lumbar spine imaging demonstrated a large, heterogeneously enhancing intradural mass with notable bony erosion. Given the thinning of the pedicles, large tumor size, and bony remodeling, instrumentation was performed in addition to decompression, with direct stimulation-triggered electromyography and intraoperative neurophysiological monitoring. This video demonstrates the surgical technique for resection and accompanied reconstruction necessary for the management of these giant intradural lesions. Postoperatively, the patient had no complications, with improvement of neurological symptoms at follow-up. Though improved, the patient had some residual numbness at postoperative follow-up visit. The patient consented to the procedure. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB, as it is considered a case report, which does not require IRB approval or patient consent.